07/12/2023
NEW WHO GUIDELINE PROVIDES STRONG ENDORSEMENT FOR EPIC CHIROPRACTIC. The World Health Organization today (December 7) launched its Guideline for the Non-Surgical Management of Chronic Primary Low Back Pain in Adults in Primary and Community Care Settings.
The Guideline presents a strong endorsement of the EPIC (evidence-based, people-centered, interprofessional and collaborative) pillars that were set out by the WFC in 2017.
Led by Professor Andrew Briggs - a keynote speaker at the 17th WFC Biennial Congress in Australia - the launch set out key elements of the guideline’s recommendations, both in terms of those interventions to be utilized and those to be avoided.
Spinal manipulation was one of the physical therapies recommended for use in all patients, including older adults. Other recommended physical therapies included dry needling, a structured exercise program and massage.
Structured and standardized education and advice were also part of the key management recommendations, as was cognitive behavioral therapy.
TENS, therapeutic ultrasound, traction and lumbar braces/supports were all found not to be of value, with recommendations against their use as part of care for adults with chronic, primary low back pain.
The Guideline was also scathing of most forms of commonly used forms of pharmacological interventions, with only non-steroidal anti-inflammatory medication receiving a conditional recommendation.
Opioids, benzodiazepines, antidepressants, anticonvulsants, muscle relaxants, cannabis-related preparations and paracetamol (acetaminophen) all received the thumbs-down, with explicit guideline advice not to use or recommend. With the exception of topical cayenne pepper (capsicum), no herbal remedies were recommended.
The Guideline was supportive of the use of multicomponent biopsychosocial interventions, repeatedly advocated by the WFC, and presenters at the launch repeatedly stressed the value of shared-decision making and the need to acknowledge patient needs, preferences and context.
Speaking after the launch, WFC Secretary-General Richard Brown commented, “This important WHO Guideline is a strong endorsement of what many evidence-based chiropractors do in their clinics and offices around the world, every single day.
“As a non-state actor in official relations with WHO, the WFC has for many years strongly advocated for a dedicated low back pain guideline that is applicable for all adults, including older people.
“We are particularly pleased to see a powerful endorsement of a biopsychosocial approach to spinal pain and disability, the importance of rehabilitation and interventions for which chiropractors are specifically trained, included in this guideline.
“Chiropractors have consistently high levels of patient satisfaction as a consequence of strong, empathic communication, a hands-on approach, their use of exercise and lifestyle advice, and their support for interprofessional and collaborative care models. The recommendations in this Guideline provide a strong case for Member States to consider integrating chiropractic within health systems at high-, middle- and low-income levels.”
The Guideline Development Group included chiropractors and received evidence commissioned by WHO from sources including WFC Research Committee Chair, Dr Sidney Rubinstein, who led three systematic reviews informing the guideline recommendations.
To access the full Guideline, Executive Summary and recommendations, go to https://www.who.int/publications/i/item/9789240081789
